Mental health patients ‘detained after refusing out-of-area beds’

Patients are being detained under the Mental Health Act after refusing to be admitted to beds at out-of-area hospitals when their local units are full.

That was the warning issued by approved mental health professionals (AMHPs), the group of mostly social workers who coordinate Mental Health Act assessments, after a survey covering AMHP leads from 70 local authorities in England indicated longstanding problems securing beds for patients in need are getting worse.

The survey was carried out by the national AMHP leads network. Almost half (48%) of respondents said patients in their areas had been detained under the act after objecting to a voluntary admission due to the distance of the admitting hospital. The last time the survey was carried out, in 2013, less than a third (32%) reported the issue in their area.

Detaining a person under the act imposes a series of restrictions on their liberty. The decision will be made by an AMHP after receiving recommendations from two doctors and only after less restrictive options, including a voluntary admission, have been considered.

‘Unacceptable’

Steve Chamberlain, chair of the AMHP leads network, said the situation was “totally unacceptable” for patients and their families, and more were objecting to long distance admissions.

“The decision AMHPs face is does this person need hospital admission now? There may be cases where you can wait until a local bed becomes available, but in others the risk will be so great to the person or those around them that they need to get to hospital urgently and you need to find a bed somewhere.

“Sometimes people are prepared to go to hospital [as a voluntary admission] but to then have to tell them ‘so we all agree you need hospital, but we’re going to have to send you 100 miles away or more’ – it’s no wonder people object.

“It’s a dreadful position for the person and their loved ones. It’s also dreadful for the AMHP because you have to weigh up whether you can wait until a local bed comes up or if the risk is so great that a detention to another hospital is necessary.”

Other findings

The survey findings, which were presented at the AMHP network’s annual conference in London, also revealed:

73% of AMHP leads had seen bed shortages lead to delays in compulsory more than five times in the past six months, up from 42% in 2013. Just 3% said this had never happened, compared to 19% three years ago.

76% of AMHP leads said they had admitted a patient to a hospital outside of their local area more than five times in the past six months, up from 60% in 2013.

75% said they had been forced to detain a person in a police cell or A&E department for over 24 hours at least once in the past six months, up from 59% in 2013. The survey did not provide a break down for cells or A&E.

One indicator from the survey showed improvement. The number of AMHP leads who had seen Mental Health Act assessments postponed at more than five times due to no suitable bed being available dropped from 37% in 2013 to 26% in 2016.

Chamberlain said the results reflected AMHPs “working hard” to see people in a timely way, only to be faced with “concerning” resource shortages after identifying the care required.

“The survey overall just confirms what we hear from staff on the ground. When you look at the beds situation, we’ve been saying for a long time it would be beyond belief for a person with a heart attack or an asthma attack to be sent to the other end of the country in an emergency. Yet this is happening in mental health.

“We want to work with the Association of Directors of Adult Social Services and others on the resource and commissioning issues, particularly in terms of how local authorities work with other agencies to deal with the problems around beds that keep coming up.”

This Tory Government don’t care about the mentally ill and don’t want to pay taxes to provide proper care. Sorry to say this but this is what you get when you vote Tory, people sleeping rough on the streets and the mentally ill being left to their own devices. Totally unacceptable in a civilised society that this is allowed to happen. This is the true face of Austerity Britain cuts imposed by the wealthy on the poorest and most vulnerable.

I totally agree with A man called horse. Mental health should be afforded the same consideration and have the same amount of funding as physical health. Many more hospitals or better still suitable bespoke accommodation should be built for people experiencing mental health issues. The figures for mental health are the same as for cancer patients yet we would find it despicable and an outcry if cancer patients were treat in the same way as people with mental health issues. Furthermore, many people with autism are detained in mental health hospitals when they do not need to be and are taking up the beds of those with serious mental health issues who need the beds. Autism is not a mental illness it is a neurological difference. It is about time those in power got their act together instead of playing ignorant, “putting their heads in the sand” and “sweeping the problems under the carpet”.

Too easy to blame the Tories on this on. I hope a legal challenge is made against AMHP’s who abuse the law by formally detaining patients willing to be admitted informally. There is no caveat in the MHA or Code of Practice which empowers AMHP’s to detain someone for refusing to go to an out of area bed. Social Workers constantly bang on about how ethical their work is yet rather than challenge the NHS for not having adequate number of local beds, choose to abuse the patient. Not sp different to Tories than are we?

Sorry Arturo, there does not need to be any caveat in order for someone to fit the criteria for ss2/3. It is purely a matter of risk to their own health or safety or that of others and this is the conundrum for AMHPs – leaving someone seriously mentally ill and at risk in the community because they object to going to a hospital out of their area is not an acceptable form of ‘challenge’ to the NHS, or more accurately Clinical Commissioning Groups.
Having said that I would be glad to see legal action taken against Commissioning bodies who fail to provide adequate inpatient resources locally as they are required to do.

I think you will find Arturo that a patient who initially agrees to an informal admission and then goes on to refuse can be legally detained. These are very difficult situations which have been compounded by a lack of resources, which can be blamed on austerity and cuts. In my own area 2 psychiatric hospitals have closed in recent years. When I worked as an ASW and then AMHP, both hospitals were running at very near capacity for the majority of the time and closing them was baffling and inexcusable. Accusing workers of not challenging the current situation is a little on the strong side. I believe that workers have been speaking out against cuts and closures, it’s just that no one in authority appears to listen.

Graham, I think you forget the bit about the least restrictive alternative bit here. Perhaps rather than cave in to and collude with reduction in hospital beds, and you are right to be pedantic, by the CCG, AMHP’s could look at treatment we in the locality/community rather than seeing the only alternative as being compulsory admission of a patient who by dint of agreeing to an admission recognises they need treatment.
Picto, in this scenario the patient has not refused an admission. I would of thought even mentally ill patients have a right to exercise choice and control over their treatment. Aren’t social workers always telling us how they work collaboratively with service users? Colluding with cuts by using the mental health act is hardly speaking against cuts so why would anybody in authority listen when we are doing their bidding and justifying it as if it really is for protection, safety and treatment.

AMHPs should have spoken up publicly and a LOT louder MUCH earlier when bed managers at their own Trusts were telling them no section, no bed. That they didn’t simply paved the way for this type of abuse of the system amongst all the others. And it is abuse. As an AMHP you might be weighing up immediate risk but detain to hospitals miles away knowing full well that the risk of suicide is then significantly raised is simply passing the responsibility buck.

As a patient I will NEVER agree to being sent out of area because it is more unsafe then leaving me in my own home. While AMHPs may complain to Community Care you don’t hear/see them speak up in mainstream media, never seen them on a single programme dedicated to MH, never see/hear them openly criticise their MH Trust colleagues, nor appear en masse representation at CCG board meetings . This is the culture of mental health – treat people as herds , as units, in a system experienced as coercive and threatening at every single level.Given most are social workers and in theory have an interest in rights based care this is appalling. And it is in this context that the actions to detain are now simply seen by people like me as action to cover their own backs. Do I ever think that an AMHP is placing my needs before the organisation’s when assessing me under the MHA – no. Do my family as carers – no. Too little, too late

an area we are not considering is the right of the Nearest Relative to ‘object’ to s3. Would it be regarded as an unreasonable objection and therefore appropriate to displace the NR if they objected on the grounds of the hospital bed being out of area? Would we deviously not tell the NR where the bed is before seeking their view if we thought there would be an issue. AMHP’s are being put at risk by having to manage the dynamic risk environment between the assessment and the bed, with little or no support from police and having to be the ambassador of flaky mental health services to the public.

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